I vividly remember our first meeting with the nursing home’s admission director. "If Betty gets aggressive against anyone, we’ll have to remove her from the nursing home," she warned. That statement always worried me. Mom was always a strong woman mentally, emotionally and physically, but she remained courteous and in control throughout her adult life. However, during the two weeks when she had stayed with me (prior to the diagnosis of Alzheimer’s), I saw a side of my mother that I had never observed. She had sudden fits of white hot anger where she would scream at the top of her lungs and threaten to break things (like a glass table top). I wasn’t sure what she would actually do, but I sure didn’t want to push her to find out.
After the diagnosis of Alzheimer’s, the doctor prescribed Risperdal, an anti-psychotic drug to keep her aggressive side under control. Unbeknownst to us, there potentially were side effects to this type of drug. Just last week, CBS News reported on a study by the Wolfson Centre for Age-Related Diseases at King’s College London that found that taking this drug (or some of the other anti-psychotic medications) may double an Alzheimer’s patient’s chance of dying within a few years. We weren’t aware of this possible outcome when Mom was alive, but if we had been, Dad and I would have had to weigh the pros and cons about whether to remove the drug from Mom’s long list of daily medications. And I think I would have advocated that she stay on the drug.
My reasoning, in hindsight, is based on two key points. First of all, if Mom had been "kicked out" of the nursing home, I’m not sure where we could have placed her. She couldn’t have lived with me at that point due to the skilled nursing that she needed. And I don’t think any other area nursing home would have taken her if she was aggressive. I’m assuming that she would have had to go back to the psychiatric ward at the hospital where she was diagnosed; in fact, the social worker at the hospital told us that Alzheimer’s patients often returned to the facility due to aggression. If this scenario had played out, it would have been a challenging one since the hospital was in a city two hours away from where I live (and at that point, Dad lived seven hours away from the hospital). Thus, Mom’s taking of the anti-psychotic drug enabled her to remain in the nursing home that was convenient to where I lived, allowing me to serve as her health advocate on a daily basis.
Secondly, Mom’s health wasn’t going to get any better. Her quality of life, because of the dementia which was made worse by her Chronic Obstructive Pulmonary Disease, was already decreasing. Therefore, Mom was in between a rock and a hard place. Taking her off the anti-psychotic drug (which, according to the study, may cause additional respiratory problems and additional damage to the brain) may have reduced her aggression, but her doctors already had warned us that because of the very weakened state of her lungs, Mom could die at any time, probably from a contagious illness that often is passed among the residents.
So if I had a time machine that could put me back in fall 2005 knowing about the Wolfson study, I would have advocated that Mom remain on the Risperdal, even knowing the risks. In my mind other factors took precedence over the possible issues with Risperdal.
As it turns out, I did learn that Mom had one aggressive interaction with one of the other residents while living in the Alzheimer’s locked unit. After the encounter (in which Mom tried to slap the woman), the staff tried to keep Mom and the other resident on opposite sides of the room. Still, there some close calls. One time I wheeled Mom past the other woman and watched as their eyes locked on each other, glaring menacingly. At the end of that particular visit, the nurse walked with me to the locked door to let me out. I worriedly asked her about Mom’s aggression toward the woman. The nurse seemed to think that the staff had it under control, and then added, "You know, we have a betting pool going on who will win between your mother and the other lady. My money’s on your mother." I laughed, relieved that they were well aware of the women’s aggressive behavior and knowing that the nurse would watch out for Mom.
Dorian Martin writes about various topics for HealthCentral, including Alzheimer’s disease, diet/exercise, menopause and lung cancer. Dorian is a health and caregiving advocate living in College Station, TX. She has a Ph.D. in educational human resource development. Dorian also founded I Start Wondering, which encourages people to embrace a life-long learning approach to aging. She teaches Sheng Zhen Gong, a form of Qigong. Follow Dorian on Twitter at @dorianmartin, Facebook or Instagram at @doriannmartin.